Direct to Computed Tomography (CT) Protocol and Impact on Door-To-Needle Time: A Systematic Review

Written by Shannon Ross, Gem P. Inay, & Dula F. Pacquiao

doi: https://doi.org/10.13178/jnparr.2024.14.01.1403

Abstract

Door-to-needle (DTN) time is a crucial metric that measures the effectiveness of using intravenous thrombolysis in the treatment of patients with acute ischemic stroke (AIS) that come to the Emergency Department (ED). Implementation of a Direct to Computed Tomography (CT) protocol is a strategy to reduce the time it takes from when an individual arrives at the hospital until they receive treatment.

Objective: To evaluate the effectiveness of a Direct CT protocol in reducing the DTN time among patients that walk into the ED via triage and synthesize available best evidence in current peer-reviewed literature associated with CT Protocol and Impact on DTN Time.

Methods: Online databases were accessed, including CINAHL, Cochrane, and Medline to conduct this systematic review. PRISMA checklist for systematic review was used, starting from search strategy to critical and methodical quality analysis. Data extracted from the studies in the review are presented in narrative form and tables were used to summarize characteristics and findings of the studies.

Results: A total of 242 studies were retrieved but only five studies met the inclusion criteria. Strong evidence exists that a Direct to CT protocol is directly correlated with significantly improved DTN time. Studies suggest that in addition to the Direct to CT protocol, there are significant opportunities to reduce DTN times by focusing on processes such as accurate diagnosis and prompt physician evaluation.

Conclusion: Implementing a Direct to CT protocol for ambulatory patients arriving in the ED and eliminating unnecessary steps in the evaluation of AIS will reduce DTN time and decrease overall mortality rates compared to not having a protocol.

Keywords: direct to CT, stroke, door-to-needle/DTN, computed tomography, emergency department